Exploring children’s health literacy in the Netherlands – results in a sample of 8-11 year olds

Abstract Background There are few valid, age-appropriate tools to assess children's HL. The German-language European Health Literacy Survey Questionnaire Adapted for Children (HLS-Child-Q15-DE) is a self-report questionnaire adapted from the adult European Health Literacy Survey Questionnaire. In 2021, this instrument was translated and validated in the Netherlands. In this presentation, we will describe the distribution of Health literacy in a sample of Dutch children, and relate their Health literacy level to certain aspects of their health behaviour such as food intake and physical activity. Methods The HLS-Child-Q15-DE was translated following WHO guidelines and administered digitally to 209 Dutch schoolchildren (eight-to-eleven-year-olds). Its psychometric properties were assessed and the sample's HL distribution was explored by demographic characteristics. Associations with food intake and physical activity were computed. Results Of the sample, 17.2% had a low health literacy score (first quintile), 61.1% medium (second to fourth quintile) and 21.7% high (fifth quintile). Higher HL scores were observed for ten-to-eleven-year-olds (compared with eight-to-nine-year-olds; p = 0.021) and fourth-grade students (compared with third-grade; p = 0.019). A positive association between children's HL and their vegetable consumption and PA behaviour was observed. Conclusions Children's health literacy can have an impact on some aspects of their lifestyle. This supports the idea that health literacy evolves throughout life and stresses the importance of both parents and schools in this process.


Background:
Although children are identified as a key target group for interventions targeting the development of health literacy, little data is available on children's health literacy and how it is related to health outcomes at a young age. This study addresses this research gap by providing data on fourth-graders' health literacy and associated health outcomes.

Methods:
A cross-sectional study was conducted among fourth-grade students in the state of North-Rhine Westphalia, Germany. The study was designed as a representative survey starting in 12/2020, which could, however, not be realized due to pandemic-related constraints. Data collected between 07/20 and 11/20 is included in the analyses presented here. Among others, we assessed self-reported health literacy with the HLS-Child-Q15 questionnaire, while also assessing various selfreported health outcomes. Results: n = 364 students are included in the analysis, 49,5% of which are female. The mean age is 9.5 years (SD = .7). The HLS-Child-Q15 demonstrated high internal consistency (Cronbach's a = .812). Self-reported health literacy is high, with a HLS-Child-Q15 mean score of 3.13, indicating that it is rather easy for participants to deal with health-related information. Health literacy is significantly associated with a number of outcomes related to health status (KINDL-R subscales physical wellbeing and mental wellbeing, Spearman's r = .280 and r = .271, respectively; p < .001) and health behaviour (freq. of brushing teeth: r = .173; p < .01; freq. of eating fruit and vegetable: r = .217 and r = .299; p < .001; freq. of physical activity: r = .279; p < .001).

Conclusions:
While the overall level of health literacy in our sample is high, higher health literacy is associated with better health behaviours, as well as improved mental and physical wellbeing. Further analyses are necessary to explore the causal pathways between the investigated variables, and representative survey are needed to verify these findings.

Background:
The questionnaire ''Measurement of Health Literacy Among Adolescents Questionnaire'' (MOHLAA-Q) was developed and validated in a multi-stage process to measure generic health literacy among 14-to 17-year-olds. The MOHLAA-Q combines subjective and objective measurements, consisting of four scales. The instrument was applied to explore associations between generic health literacy and different health behaviors among adolescents in Germany. The data should contribute to the age-appropriate development of health promotion interventions.

Methods:
We carried out a nationwide cross-sectional online survey with 1,235 adolescents aged 14-17 years in Germany in 2019. Data on generic health literacy were collected using the four scales of the MOHLAA-Q and data on health behaviors were collected using single established single-item questions on sports, diet, alcohol consumption, and smoking. Bivariate and multiple analyses were performed for investigating associations between generic health literacy and health behaviors, adjusted for age, gender, education and self-efficacy.

Results:
Not consuming fruit and vegetables daily was associated with lower health literacy levels in all examined scales. Doing no sports as well as smoking showed positive associations with low levels in ''health-related communication and interaction skills'' and ''attitudes toward one's own health and health information''. No associations were found between risky alcohol consumption and health literacy.

Conclusions:
The results indicate that strengthening health literacy should be part of health promotion activities for increasing physical activity and healthy diet among adolescents. The MOHLAA-Q allows us to identify which specific dimensions of health literacy might be addressed in order to promote different health behaviors.
presentation, we will describe the distribution of Health literacy in a sample of Dutch children, and relate their Health literacy level to certain aspects of their health behaviour such as food intake and physical activity.

Methods:
The HLS-Child-Q15-DE was translated following WHO guidelines and administered digitally to 209 Dutch schoolchildren (eight-to-eleven-year-olds). Its psychometric properties were assessed and the sample's HL distribution was explored by demographic characteristics. Associations with food intake and physical activity were computed.

Results:
Of the sample, 17.2% had a low health literacy score (first quintile), 61.1% medium (second to fourth quintile) and 21.7% high (fifth quintile). Higher HL scores were observed for ten-to-eleven-year-olds (compared with eight-to-nineyear-olds; p = 0.021) and fourth-grade students (compared with third-grade; p = 0.019). A positive association between children's HL and their vegetable consumption and PA behaviour was observed.

Conclusions:
Children's health literacy can have an impact on some aspects of their lifestyle. This supports the idea that health literacy evolves throughout life and stresses the importance of both parents and schools in this process.
Abstract citation ID: ckac129.321 Health literacy among adolescents: summary of some key findings from ten European countries

Introduction:
In research on disparities, the concept of health literacy (HL) as a set of competencies to promote and sustain health may help in understanding the disparities better and in addressing avoidable and unfair health disparities. The presentation will present some key findings on adolescents' HL levels in ten European countries, and how HL mediates and moderates between various background factors and health outcomes. Methods: Data consisted of cross-sectional data from Health Behaviour in School-aged Children (HBSC) study from year 2017/18 of ten European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia). Data (n = 14,291) of 13-and 15year-old pupils were used. Indicators include background variables (e.g. age, gender), Health literacy, Health indicators (e.g. self-rated health (SRH) and problematic social media use (PSMU)). Analysis include (1) Mediator analysis (with Mplus): pearson correlation coefficients, path models (Mplus 7.3 and Maximum Likelihood estimator) and (2) random effects models and moderator analyses (with R-sofware). Findings: HL is an independent factor explaining disparities in health (e.g. SRH), and a mediator as well as a moderator between health outcomes and background factors. Based on the national analyses HL had significant main effects in every country, but group level differences emerged only in some countries. For instance, in Finland and Belgium, among girls HL lowered the likelihood to problematic social media use, but not among boys. Discussion: HL is of use in understanding and tackling health disparities among adolescents. Results confirm the need to adopt the principles of proportionate universalism when promoting HL among adolescents to avoid widening the disparities within population groups. Also, country-specific health literacy interventions are needed to secure equity in opportunities of different population groups to benefit from the HL interventions.